About the job
Primary Responsibilities:
- Screen incoming information and connect members with the appropriate providers, or reach out to providers on behalf of members.
- Facilitate the authorization process for requests that do not necessitate clinical judgment or criteria applications.
- Provide essential information to members and assist them with Plan-related inquiries in the absence of Member Services personnel.
- Serve as a resource for team members regarding the prior authorization process.
- Escalate unresolved questions about the prior authorization process to the Lead Intake Specialist.
- Assist the Lead Intake Specialist in developing, planning, and executing staff training initiatives.
- Identify and report educational opportunities for members and providers to the Lead Intake Specialist.
- Accurately respond to inquiries regarding Plan benefits and Utilization Management requirements for both members and providers.
- Conduct inquiries to assess potential coordination of benefits and communicate findings to the relevant provider and claims staff.
- Support Utilization Management nurses with data entry tasks.
- Perform additional duties as assigned.
- Adhere to the policies and procedures of Select Health and KMHP.
- Uphold and promote the mission and values of Select Health and Mercy.
